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Total knee replacement in patients older than 85 years.
1Hospital for Special Surgery, New York, New York, USA.
Clinical Orthopaedics and Related Research
|November 5, 1999
Summary
Total knee replacement in patients over 85 significantly improves quality of life and function, with most returning to independent living. Epidural anesthesia reduced postoperative confusion in this elderly cohort.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
Background:
- Total knee replacement (TKR) is a common procedure for osteoarthritis.
- Limited data exists on TKR outcomes in the very elderly population (over 85 years).
Purpose of the Study:
- To evaluate the outcomes and quality of life after unilateral total knee replacement in patients aged 85 and older.
Main Methods:
- Retrospective study of 62 patients over 85 undergoing TKR between 1987-1995.
- Follow-up for a minimum of 2 years (mean 5.4 years).
- Comparison of outcomes between general and epidural anesthesia.
Main Results:
- High rates of preoperative cardiac comorbidity (70%) and postoperative confusion (higher than younger patients).
- Improved functional outcomes: mean knee score 89, mean pain score 43/50, mean flexion 114 degrees.
- Most patients maintained independent living (76%) and mobility (85% could travel independently), with significant quality of life improvement.
Conclusions:
- Total knee replacement is a valuable procedure for patients over 85, leading to enhanced quality of life and functional independence.
- Epidural anesthesia may reduce postoperative confusion in this age group.
- Despite challenges like cane use, TKR enables a more functional lifestyle for the very elderly.